Hair Loss

Also called alopecia

Hair loss occurs because the cells of the hair follicles grow rapidly, which makes them sensitive to the effects of some cancer treatments.

Causes

Radiation therapy

Radiation therapy to any area of the body can cause hair loss in the area where the radiation was given. The amount of hair loss and whether it comes back depends on the dose of radiation given. Permanent hair loss is more common when higher doses of radiation are given.

Chemotherapy

Hair loss is a common side effect of chemotherapy, but not all drugs cause hair loss. The amount of hair loss and when it comes back depends on:

• the type of drug
• the dose of drug
• length of treatment
• personal factors

In most cases, hair loss is temporary.

Some chemotherapy drugs that can cause hair loss include:

Symptoms

Hair may become thinner or it may fall out entirely. Hair may fall out gradually or suddenly. It usually falls out in clumps. Hair loss may not happen right away and often begins 2 to 3 weeks after starting chemotherapy treatment or radiation therapy. Remaining hair may become dull or dry.

Hair loss can occur on all parts of the body:

• on the head (the scalp may also feel tender)
• facial hair (some or all of the eyelashes and eyebrows)
• body hair (including pubic, chest and underarm hair)

Loss of facial and body hair is usually less severe, because hair grows less actively in these areas than on the scalp.

Management

Measures to help cope with hair loss include:

• For long or medium-length hair, get a shorter cut to make hair look fuller and thicker. It might also help to make hair loss less dramatic.
• Be gentle with hair. Use a mild shampoo, a soft hairbrush and a hair dryer set on low heat or let hair dry naturally.
• Avoid colouring (hair dye), perming or straightening hair during treatment. These products contain chemicals that can damage hair.
• Try wearing a scarf, turban or hat if feeling sensitive about hair loss. This also helps keep the head warm.
• Consider buying a wig or toupée. Try to select it before hair falls out so that it is easier to match to one's own hair colour and style. Check with provincial and private health insurance about coverage for wig purchases.
• Protect the scalp when going outside. Wearing a wide-brimmed hat or scarf can help. Use a sunscreen on the scalp when outside if a hat is not worn.
• Make-up may be used when eyebrows or eyelashes thin or fall out because of treatment. The Look Good, Feel Better program volunteer can suggest make-up techniques (using eyeliner, for example) that can help to fill in or recreate them.

Scalp cooling and scalp tourniquets

Scalp cooling (hypothermia) and scalp tourniquets are methods that have been used to try to reduce hair loss during chemotherapy. Scalp cooling may be done by placing ice packs or using special temperature-controlled devices (sometimes called a cold cap) on the scalp. A scalp tourniquet is a narrow inflatable cuff or band that is put on the scalp and is then filled with air, which puts pressure on the scalp. Scalp cooling and tourniquets both attempt to reduce blood flow to the scalp and decrease the amount of drug that reaches the hair follicles.

These methods are not very useful because chemotherapy drugs tend to stay in the bloodstream for several hours. Some studies on the effectiveness of scalp cooling are inconclusive or show that these may only be beneficial for certain drugs.

Scalp cooling and scalp tourniquets are not recommended for people being treated for cancers that may have hidden metastases to the scalp, such as melanoma, leukemia, lymphoma or cancers that spread through the bloodstream. Because these devices decrease blood flow to the scalp, they may interfere with how the drug is circulated and the scalp may end up not being treated.

Hair regrowth

Hair usually grows back once treatments are completed. The time for this can vary. Many people find that their hair starts to grow back before their chemotherapy treatment is finished or very soon afterwards, usually within 4 to 6 weeks. With radiation therapy, smaller doses usually result in temporary hair loss in the radiated area. Regrowth usually starts about 3 to 6 months after treatment is completed.

Some people find that their hair comes back in a different texture (finer or coarser), colour (lighter or darker) and type (straight or curly). These changes are usually temporary. It may take one year or longer before hair completely grows back and returns to its original type.

When hair regrows, it may not be as strong as it was before and weak hair is more prone to breakage. Products like perms, hair dyes or chemical hair strengtheners should not be used until hair returns to normal. This may take as long as 6 months or more after treatment. Talk to the healthcare team about when it is okay to use these products again.